Compare Your Options with Delta Dental

The following chart depicts the three plans offered to you under the Delta Dental Veterans Affairs Dental Insurance Program. When treatment is provided in-network by a Delta Dental PPO (DPO in Texas) network dentist your cost shares will be substantially lower. Your total out-of-pocket costs will increase when your care is provided by an out-of-network dentist. If you’re currently seeing a network dentist, you’re already saving! If not, or you’re unsure check the Dentist Directory to find a network dentist near you.

Plan Summary and Comparison

Plan Summary of Benefits Network Percentage

Service Category

Standard

Enhanced

Comprehensive

In Network

Out of Network

In Network

Out of Network

In Network

Out of Network

Year 1+

Year 1

Year 2+

Year 1

Year 2+

Year 1

Year 2+

Year 1

Year 2+

Diagnostic1

100%

80%

100%

100%

80%

80%

100%

100%

80%

80%

Preventive1

100%

80%

100%

100%

80%

80%

100%

100%

80%

80%

Basic Restorative

50%

30%

50%

50%

30%

30%

60%

60%

40%

40%

Major Restorative2

NAB

NAB

NAB

NAB

NAB

NAB

NAB

50%

NAB

30%

Endodontics2

NAB

NAB

NAB

50%

NAB

30%

NAB

50%

NAB

30%

Periodontics2

NAB

NAB

NAB

50%

NAB

30%

NAB

50%

NAB

30%

Oral Surgery2, 3

50%

30%

50%

50%

30%

30%

50%3

50%

30%

30%

Prosthodontics2

NAB

NAB

NAB

NAB

NAB

NAB

NAB

50%

NAB

30%

General Services

NAB

NAB

NAB

NAB

NAB

NAB

50%

50%

30%

30%

Orthodontics

NAB

NAB

NAB

NAB

NAB

NAB

NAB

NAB

NAB

NAB

Deductible

$50

$50

$501

$501

$501

$501

$0

$0

$501

$501

Annual Maximum

$500

$500

$1,000

$1,000

$1,000

$1,000

$1,500

$1,500

$1,500

$1,500

NAB = Not a Benefit

1The deductible is waived for diagnostic and preventive services; under the Enhanced plan. Under the Comprehensive plan the deductible is waived for diagnostic and preventive services provided out-of-network, and there is no deductible for any services provided in-network.

2Enhanced Plan: The waiting period is twelve (12) months for endodontics and periodontics. Comprehensive Plan: The waiting period is 12 months for major restorative, endodontics, periodontics, oral surgery,3 and prosthodontics.

3Simple extractions (procedure codes D7111 and D7140) are the only oral surgery services covered under the Standard and Enhanced plan, and the only services covered in the first 12 months under the Comprehensive plan.